00070013CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDING ADDRESS: '
'D :70 149STAGRES DR
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PHR1,1I'1' NO.
OWNER'S NAME:
LIFETIME POOLS TI
APPLICATION. 6
SHAP 1 RG GARY
s PHONF,:
910 SAN ANTONtO RD
SANITARY N
zO ARCHITECTIENGINHER:
RUILDING VERMl"r INFO
BLD'/" ELECT PLUMB NI
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j LICENSEDCONTRACfOR'SUECLARA'I'1°N
Job Description
hereby I
purenJviPsrioonreszosifn
Bd uasnindeers
witM1 Senion]IN0) 4�I"he n, Codee,.t an(mJ mmymlicense
FFllllr''ite �te1n
ccnsell li,rcr�..y` ]eT�
Clan ✓✓✓✓✓✓ �ic.a_, )Y—y-�J���
POOL
on
CCCCCC ARCIII rECI"S UIiCLA d„ OR' ;
g I undcmm�J my plans %M1all he used as puhl c N.
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OLicensed P oressimed
OWNER-BUILDI!R DECLARATION
so I hereby affimt that two mcntpl Intel, the Cnnlmctnh Lioenxe Law m the
following reason. (Section ]03 1.5, Business and professions Cet Any city or county
o which requires a perinit to cnmlmcl, alter, i,npruve, demolish, or repair any structure
,
prior to its issuance, slot requires the applicant fnrnuch permit o file a signed statement
Sq. Ft. Floor Area
Valuation
— that he I, liccnscd rare.told to'he Pro,oin", of the Contrnc,nre hicc,wc Law (chapter 9
(commencing with Section 7gMB of Division 3 of the Bovine, and Is ofes.ions Cale)
n lhm he is exempt therefrom and he brie partite alleged exemption. Any violation
of Section MIS by any applicant lin a permit subject%,he applicant ma civil penally
APN Number
la•
olmn more than Five, hundred dollar l s500),
❑ I, a> owner or the propert, or my employees with wages us their tele crnpensaunn.
3 ulred Inspections
will do the, of and the ..'...lure is nm one led lir n hoed lin s;do Sec. 70,14,
Raines mud Probo,ions Code: Me Comracmr: License Law does on, apply n, an
owner nl'pmleoy Who huiWs or intptvm thereon, and who don such wink himself
'
or through his own eml provided that such improvements are not intended lir
ohered for sock. If, hnwevec the budding or improvement in sold within one year of
103 — UFE R
completion, the ownefbaldcr will have the burden ol'plosing that he dl%I not build or
1.04
in,pnwernrpurpmenf.ale.L
— REBAR
01,a—si ernnheptperty.amesem%iv<lycontractingwithRatnsedcontractors n
107 — POOL/BONDING
cn i've" the prnjem (Sec. ]e,4. Bmina%% and rmfev.ion% Code:) The contract..
License Law cost not apply to an owner lir property who build%or impmees Jtercml.
301. — ROUGH PLUMBING
and who contracts rte such projects with u ormcmrv) licensed pumnam to the
304 — ROUGH ELECTRICAL -
Contractors Llceme Law..
Cl I nm r%empl ander Sec. . B .F P C ern teis reason
502 — FINRL PLUMBING ENERGY
Owner WORKER'S CONIVENSAnnN DECLARAnON
503 — FINAL MECHANICAL ENERGY
I heoch, muter %mer penally ofredurr tete none hdlowirg dechre"',
506 — GAS TEST
❑ 1 have aid will maintaht a Certificate of Cement to .Hl-brure for Worker,
'Clonpcmminn,
510 — FINAL PLANNING
as p.,idcd far by Section 390(1 of ,he Labor Code, rte the
511 — FINAL POOL
performance of the work for which this permit in issued.
516 — FINAL BUILDING
O 1 have and will mainmin Worker's Compensation Insurance, as resent by Section
Orb or the Labor Code.
l/tM11ee perrormmnce of the work for which this went is
y�forr
se
tPol my Nunier no c�dvfg5 7—
'`J
Came�B`kd [_ te
CEHI'IFICATIONOFEMIA PION FROM WORKERS'
CONIPENSATION INSURANCE.
(ods section need ,tot Ire con d,fol d the permit is I'nr tete hundred dollan
(yam
is 100) no les'.)
1 certify that in the peffimovnce of the work lin which this permit is Issued, 1
^
/
shill not employ any person in any manner su a% 10 become subject In the Workers'
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Compensation Law, of California. Dam
V
Applicant
Nol TO APPLICAN'L I1, alter nntking phis cen'll it lisnnptlnn, you should
it, become%objectto the Workers Compensation provisions of the i,htr Code. you must
forthwith comply with such no,oians lir this arrnh vital he dermad revoked.
n CONSTRUCTION LENDING AGENCY
> 1 herby .from that them is a conswrlion lending agency for the Nrlbormnnce
of the work far which this permit is issued (Sea. 300. Civ, C.)
Isnder's Name
7 Lcnder's Adl
I certify that I have read this applienim ant! smte that the above infnnnation is
reel. 1 agree m a ir,ly .,It all city and en..1, adi ance, and one pews relining
mo Wilding construction. and hereby authorize representatives of fir, city to enter upon
Ihr h tioned propertyf .p:ni purposes.
y (Wt) agree 1. xtl ridermly and keep h ,Jess the C,l,ofC.,oioo aunt
n Inabilities. jud,mem, c is d xpe ms 'neir may in any »ray accrue against said
Z City tcotseque 1111 g b f@i I d
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PPLICA' UNDEftSTANUSAND WILLCOMPLY WRH ALLNON POINT
•'
Issued by: /// Date
SOUILQiIO 5.�
7L/�
.
Sigodmr Applica,ttR:nntmr,nr Lime
Re -roofs '
11A%A Inner MATERIALS DISCI c)SURE
emreor hazardous medal
Will he in litunim,lCod
o
Type of Roof
Chat old
n derned by the Cupcnlno Alunicipal Cala. Chapter 9.12, arta the [Icahn and Safety
Code, Section 23532[u)'!
El yes - 0 N
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant lir litom building oecupat ase equlptncm lir deuces which
If a roof is installed without first obtaining an inspection, 1 agree to remove
emit hazardous air cmlamirums us defined by the Bay Ana Air peal ply Management
all new materials for inspection. Applicant understands and will comply with
Dl.lrml3
! ❑sae, 0 N
all non -point source regulations.
I hove rcaJ rite haeurdom malarial, requirements under Chapter 6s95 of the
Culifierm Health le Safety Code, Sections 25505, 25533 and 25534. 1 understand the
if the building does not currently have a cranL[hat itislily reepnn%ihility to notify the
occupant of the requirements which must be net prior In issuance of a Certificate of
ore ,p: ey. y�,�
7�6��
Signature of Applicant Date
"13" better
�.,
All roof coverings to be Class or
bxmer a�IR� dagent
1.01 Y[N3